Evaluation of a Nursing Theory

Forming a Complete Description:

Six Questions are Propose for Describing Theory.
1. What is the purpose of this theory?
This question addresses why the theory was formu-
lated and reflects the contexts and situations to which
the theory can be applied.
2. What are the concepts of this theory?
This question identifies the ideas that are structured
and related within the theory. It questions the quali-
tative and quantitative dimensions of concepts.
3. How are the concepts defined?
This question clarifies the meaning for concepts
within the theory. It questions how empiric experi-
ence is represented by the ideas within the theory.
4. What is the nature of relationships?
This question addresses how concepts are linked together.
It focuses on the various forms relationship statements
can take and how they give structure to the theory.
5. What is the structure of the theory?
This question addresses the overall form of the con-
ceptual interrelationships. It discerns whether the theory
contains partial structures or has one basic form.
6. On what assumptions does the theory build?
This question addresses the basic truths that underlie
theoretic reasoning. It questions whether assumptions
reflect philosophic values or factual assertions factual
assertions.
 Guide for the Description of Theory
1. PURPOSE
 Why is this theory formulated?
 Is there an overall purpose for the theory? A
hierarchy of purposes? Separate numerous purposes?
 Is there a purpose for the nurse? The person

receiving care? Society? Environment?

 How broad or narrow is the purpose?
 What is the value orientation of the purpose?
Positive, negative, neutral?
 1. PURPOSE
 Does achieving the theoretic purpose require a
nursing context?
 Does the purpose reflect understanding?
Creation of meaning? Description, explanation,
and prediction of phenomena?
 When would the theory cases to be applicable?
What is the end point?
 What purpose not explicitly embedded in the
matrix of the theory can be identified?
 2. CONCEPTS

 Is there one major concept with sub-concepts

organized under it?
 How many concepts are there?
 How many major (or minor) ones?
 Can the concepts be ordered, related? Arranged
into any configuration?
 2. CONCEPTS

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?
 How abstract or empiric are the concepts?
 What is the balance between highly abstract and
highly empiric concepts?
 3. DEFINITIONS
 Which concepts are defined? Which are not?
 Which concepts are defined explicitly? Which are
implied
 How much meaning needs to be inferred ?
 Which concepts are defined specifically?
Generally?
 Are there competing definitions for some concepts?
Are there similar definitions for different concepts?
 Are any concepts defined contrary to common
convention?
 4. RELATIONSHIPS
 What are the major relationships within the theory?
 Which relationships are obvious? Which are implied?
 Do relationships include all concepts? Which are not
included?
 Are some concepts included in multiple relationships?
 Is there a hierarchy of relationships? Do relationships
create meaning and understanding? Do they do this by
describing, explaining? Predicting? What mix of
each?
 Are relationships illustrated?
 5. STRUCTURE
 How are overall and individual ideas organized?
 If outlined, what would the theory look like?
 Do relationships expand concepts into large
wholes or vice versa ? Do they link concepts in a
linear fashion?
 Does the structure move concepts away from or
toward the purposes?
 Are there several structures that emerge ? What
is their form? Do they fit together?
 6. ASSUMPTIONS
 What assumptions underlie the theory? Are
assumptions explicit, implicit, or derivable from
context and meanings?
 What are the individual, nurse, society,
environment, and health assumed to be like?
 Do assumptions have an obvious value orientation?
What is it?
 Could assumptions be factually verified?
 Can assumptions be hierarchically arranged or
otherwise ordered?
Criteria for the Evaluation of Theory

 Dudley-Brown, S. L. (1997). The evaluation of nursing

theory: a method for our madness. International Journal of
Nursing Study, 34(1), 76-83.
 Accuracy
 Accuracy, according to Webster’s, as a noun, is
defined as exactness or precision, while as an
adjective, as without mistakes or errors.
 Kuhn (1977) accuracy as a characteristic of a good
theory.
 Synonyms of accuracy include perfect, just, truthful,
and correct.
 In relation to nursing theory, accuracy pertains to
describing nursing as it exists today, not the nursing
of the future or of the past.
 Consistency
 Consistency is used frequently in describing
criteria for the evaluation of theory.
 Kuhn (1977) describes consistency in terms of
the theory being internally consistent as well as
being consistent with accepted theories.
 Internal consistency, however, has been
described by another philosopher, Newton-
Smith (198 l), as consistency in language, the
existence of logical order, and connectedness.
 Consistency
 Inconsistencies should be avoided, a theory with
an inconsistency does not necessitate that the
whole theory be scrapped.
 Meleis (1985)describes, is to have consistent
operational definitions and concepts that are
consistent with assumptions and propositions.
 Meleis also uses the terms coherent and logically
presented to describe clarity.
 Fruitful
 Fruitful, is related conceptually to criteria
proposed by others.
 Synonymous with fertile, bountiful, productive, and
prolific.
 Kuhn (1977), in describing fruitful, states that
theory should expose new feelings, new
phenomenon, or previously unknown relationships
among phenomenon already known.
 Fruitful refers to success in explaining observable
phenomenon, and the evaluation of empirical work
resulting from a theory.
 Fruitful
 Newton-Smith (1981) describes (fertile) as the scope
for further development.
 The theory should contain ideas to further research.
 Consistent with this is Ellis’s (1968) criteria of
generation of information-the theory should generate
hypotheses.
 Ellis (1968) states “A theory that generates many
hypotheses, even some without high probability, or
some that are difficult to test, can contribute to
understanding.
 Simplicity
 Simplicity as an important evaluative criterion (Kuhn,
1977; Newton-Smith, 1981; Chin and Jacobs, 1983)
others propose complexity (Ellis, 1968; Barnum, 1990).
 Meleis (1985) takes a more pragmatic approach: whether
the theory has a lot of phenomena and relationships
(complexity) or if it focuses on fewer concepts and few
relationships (simplicity)?
 Kuhn’s, (1977) describes as “bringing order to
phenomenon that in its absence would be isolated and
confused”.
 Simplicity is a seemingly useful characteristic of a good
theory in nursing, and important in the evaluation of
nursing theory.
 Scope
 Scope has been dichotomized as either broad or narrow.
 Ellis (1968) and Hardy (1974). “The broader the scope,
in terms of the number and variety of facts or concepts
related, the greater is the significance of the theory” .
 Hardy (1974) states “the more general a theory, the
more useful it is.”
 Broad vs. narrow scope can also be dichotomized in
relation to its generalities, or the use of the term theory
and conceptual framework/ model.
 Scope may be conceptualized in relation to the level of
theory, eg. a grand theory or middle range theory.
 Acceptance
 Meleis (1985)states acceptance “when the theory
begins to cross several concentric circles from where it
originated, its circle of contagiousness increases and we
can infer that the theory is receiving more acceptability,
uninfluenced by the theorist” .
 Laudan (1977) discusses the importance of acceptance
and pursuit by other members of the discipline in that
the theory shows promise if others are accepting and
‘buying into’ the theory.
 It is important for the advancement of nursing as a
profession to have members of the discipline
communicate regarding its multicultural acceptance and
adoption by others.
 Testability
 Testability refers to the theory’s research potential or
empirical adequacy.
 Testability has been long felt to be an important
criterion for the evaluation of nursing theory, and touted
as a method to advance the science of nursing.
 Acton et al. (1991)and Silva (1986) describe how the
lack of empirical validation of nursing theory has
hindered the development of nursing science.
 Silva and Sorrel1 (1992) have proposed criteria for
evaluating theory-testing research, and discuss
important philosophical and methodological issues in
the testing of nursing theory.
 Socio-cultural utility
 Socio-cultural utility encompasses social congruence
and social significance
 Johnson (1974), Meleis (1985) and Fawcett (1989)in
their criteria for the evaluation of theory.
 Social congruence encompasses the beliefs, values and
expectations of different cultures that should shape and
direct the type of theory most useful to it.
 As Meleis (1985) explains, self-care and independence
are goals consistent with some cultures’ value systems
but not others.
 Theories with such goals would be incongruent and
inappropriate in some societies and cultures, and should
be avoided.
 Conclusion of criteria for the
evaluation of theory
 Nurses in all roles will hopefully use these criteria
proposed here to guide their choice of theory when using
nursing theory in practice, education and research.
 There has been a dearth of empirical testing of theories in
nursing, testing is only one part of the evaluation of theory.
 A set of criteria for the evaluation of theory has been
proposed here that includes: accuracy, consistency,
fruitfulness, simplicity/complexity, scope, acceptability
and socio-cultural utility.
 Theory Critique

 Meleis, A. I. (2007). Theoretical Nursing: Development &

Progress (4rd ed.). Philadelphia. PA: Lippincott.(Ch9)(pp.186-
211)
Table 11-5
THEORY CRITIQUE— RELATIONSHIP BETWEEN
STRUCTURE AND FUNCTION; DIAGRAM OF THEORY;
AND CIRCLE OF CONTAGIOUSNESS
CRITERIA UNITS OF ANALYSIS
Relationship Clarity
between structure Consistency
and function Simplicity/Complexity
Tautology Teleology
Diagram of theory Visual and graphic presentation
Logical representation
Clarity
Circle of Geographical origin of theory and geographical
contagiousness spread influence of theorist vs. theory
Table 11-6
THEORY CRITIQUE—USEFULNESS

CRITERIA UNITS OF ANALYSIS

Practice Direction Cost effectiveness
Applicability Relevance
Generalizability
Research Consistency Predictability
Testability
Education Philosophical statement Concepts
Objectives
Administration Structure of care Organization of care
Guidelines for patient care
Patient classification system
Table 11-7
THEORY CRITIQUE—EXTERNAL COMPONENTS
OF THEORY
CRITERIA UNITS OF ANALYSIS
Personal values Theorist implicit/explicit values
Critic implicit/explicit values
Congruence with other Complementarity
professional values Esotericism
Competition
Congruence with social Beliefs
values Values
Customs
Social significance Value to humanity
Forming a complete critical reflection
1. Is this clear?
 This question addresses the clarity and consistency of
presentation.
 Clarity and consistency may be both semantic and
structural.
2. Is this simple?
 This question addresses the number of structural
components and relationships within theory.
 Complexity implies numerous relational components
within theory; simplicity implies fewer relational
components.
Forming a complete critical reflection
3. Is this general?
 This question addresses the scope of experiences covered
by theory.
 Generality infers a wide scope of phenomena, whereas
specificity narrows the range of events included in theory.
4. Is this accessible?
 This question addresses the extent to which concepts
within the theory are grounded in empirically identifiable
phenomena.
5. Is this important?
 This question addresses the extent to which theory leads
to valued nursing goals in practice, research, and
education.
Guide for the critical reflection of theory
1.HOW CLEAR IS THIS THEORY?
 Are major concepts defined?
 Are significant concepts not defined? Are definitions
clear? Congruent ? Consistent?
 Are words coined? Are coined words defined?
 Are words borrowed from other disciplines and used
differently in this context?
 Is the amount of explanation appropriate? Too much?
Not enough?
 Are examples or diagrams helpful? meaningful?
 Not helpful? Needed and not present?
 1.HOW CLEAR IS THIS THEORY?
 Are basic assumptions consistent with purposes?
 Is the view of person and environment compatible ?
 Are the same terms defined differently?
 Are different terms defined similarly?
 Are concepts used in a manner consistent with their
definition?
 Are compatible and coherent structures suggested for
different parts of the theory?
 Can the theory be followed?
 Are there any ambiguities as a result of sequence of
presentation?
 Does the theorist accomplish what she or he sets out to do?
 2.HOW SIMPLE IS THIS THEORY?
 How many relationships are contained within the
theory?
 How are the relationships organized?
 How many concepts are contained in the theory?
 Are some concepts differentiated into sub-concepts?
 Can concepts be combined without losing theoretic
meaning?
 Is the theory complex some areas and not in others?
 Does the theory tend to describe, explain, or predict?
Impact understanding? Create meaning?
 3.HOW GENERAL IS THIS THEORY

 How specific are the purposes of this theory?

Do they apply to all or only some practice areas?
When?
 Is thus theory specific to nursing? If not, who
else could use it? Why?
 Is the purpose justifiably a nursing purpose?
 If subpurposes exist, do they reflect nursing
actions? How broad are the concepts within the
theory?
 4.HOW ACCESSIBLE IS THIS THEORY

 Are the concepts broad or narrow?

 How specific or general are definitions within the theory?
 Are the concepts’ empiric indicators identifiable in
reality? Are they within the realm of nursing?
 Do the definitions provided for the concepts adequately
reflect their meanings?
 Is a very narrow definition offered for a broad concept? A
broad meaning for a narrow concept?
 If words are coined, are they defined?
 5.HOW IMPORTANT IS THIS THEORY?
 Does the theory have potential to influence nursing actions? If
so, to what end?
 Does the theory influence nursing education? research? If so, to
what end? Is that end desirable?
 Hoe specific are the purposes of the theory? Do they provide a
general framework within which to act or a means to predict
phenomena?
 Is the theory’s position about people, about nursing, and about
the environment consistent with nursing’s philosophy?
 Given the purpose of the theory and its orientation, what of
significance for nursing or health care has been omitted?
 5.HOW IMPORTANT IS THIS THEORY?

 Is the started or implied purpose one that is important to

nursing? Why?
 Will use of the theory help or hinder nursing in any way?
 Will application of this theory resolve any important
issues in nursing? Will it resolve any problems?
 Is the theory futuristic and forward-looking?
 Will research based on the theory answer important
questions?
 Are the concepts within the domain of nursing?
 Do I like this theory? Why?
 Conclusion
 Theory development and evaluation are cyclical,
continuous, and dynamic process. One can not exist
without the other.
 Theory evaluation including description, concept analysis,
theory critique, testing and support.
 These process are based on the view that science is a
human process that includes not only valid findings but
also observation, agreements, useful solutions to problems.
 Theory evaluation is central to the development of theory;
it is the responsibility of each clinician, academician.
 Conclusion
 Kuhn(1977) “we can delineate such criteria and that
accuracy, consistency, broad scope, simplicity and
fruitfulness in research are essential as objective criteria
for judging competing theories”
 However, “every individual's choice between competing
theories depends on a mixture of objective and
subjective factors”
 The subjective factors are dependent on individual's
preferences and personalities.
 Both objective and subjective factors have a place in our
understanding of the philosophy of science.
Adaptation Model
 Exercise: Application of Roy's
Adaptation Model in Nursing Practice
http://currentnursing.com/nursing_theory/appli
cation_Roy's_adaptation_model.html
1. What is the purpose of this theory?
2. What are the concepts of this theory?
3. How are the concepts defined?
4. What is the nature of relationships?
5. What is the structure of the theory? .
6. On what assumptions does the theory build?